HCA: It's Hospital Policy To Shakedown Patients Before They Leave

By consumeristcareyMay 25, 2008

It is hospital chain HCA’s policy to “wrest as much cash as humanly possible out of patients before they leave the building,” even if the patient hasn’t yet recovered from major surgery. The bedside shakedowns occur before the for-profit hospital submits its claims to the insurance company, shifting the burden of payment from insurance companies to patients. Stephanie Mencimer wrote about her experience with HCA after her father underwent knee replacement surgery:

Among the many hospital personnel who stopped in to see my father after surgery was a “financial counselor” from the billing office, who basically started stalking him from the minute he left the intensive care unit.

After making several unsuccessful visits to his room on Tuesday and Wednesday, she slipped her card under the door asking my dad to call her. A little busy recovering from major surgery, my dad didn’t get around to it. So on Thursday, the woman called him on the phone in his room, waking him from a much needed painkiller-induced nap to demand a $1,500 down payment on his surgery.

Still connected to IVs, a morphine pump and creepy-looking blood drains, my dad had enough to worry about without getting hassled by the billing office, like dying from a blood clot, or acquiring a drug-resistant infection from the guy in the next room. (Family and hospital staff alike were visiting the guy barehanded despite a big sign on his door warning people not to come within three feet of him without gowns, gloves and masks.) So I went down to the billing office to complain. A supervisor informed me that the counselor was making a “courtesy call” to inform my dad of the limits of his insurance policiy, but she acknowledged that it was hospital policy to wrest as much cash as humanly possible out of patients before they leave the building.

I told the supervisor that hassling post-op patients was incredibly inappropriate, especially given that most of them were too doped up on painkillers to even sign a consent form, much less negotiate billing options. If the hospital had wanted to discuss payment issues, it could have done so when my dad pre-registered with the hospital two weeks earlier. After some perfunctory apologies and some lame excuses, the woman thanked me for the feedback and I left. Later a nurse told us another patient had also complained of a similar shakedown, and she said the nurses were horrified but powerless to do anything about it.

Disgusting, but emblematic of for-profit hospitals. Avoid them if you can.

There was an even worse situation outlined in a Wall Street Journal article. An individual receiving chemotherapy had to pay quite a bit of their treatment costs upfront. Of course they were not financially able to cover the costs.

At one instance, the staff would not start an IV dispensing the medication until the billing department received a payment.

Yea this is true. I also agree that the health care system is out of control and something major needs to be done about it.

Also remember that the hospital he went to is a for profit business. It exists to make money. Were they out of line? Yea I think they could have done better. It just shows what they had to go through to collect though.

I understand why the hospital is doing this. As Here_we_go mentioned hospitals don’t get paid. They are trying to get as much money as possible. It’s pretty crappy to go after patients just after surgery, but what other choice do they have? They can go out of business easily. There were quite a few hospitals in the Jersey area that closed their doors over the last few years, mostly because people didn’t pay their bills.

3.5 years ago we had a baby. My wife was on Medicare, the child was on my private insurance. Medicare overlaps with the private insurance too much to make putting both of them on my insurance a good deal.

The hospital did ask us to arrange payment options before we left (we responded by writing them a check). We just did it again, but this time they called a couple weeks ahead of time to set it up. We decided on the same course, but at no chance did they give us a chance to provide the insurance on the unborn child.

After the child was born and coverage became available (retroactive to birth) we provided the insurance to the hospital. When we got the discharge paperwork I went to pay the bill. They decided to just bill us because of the last minute change of insurance.

As a Canadian who has had family members fall ill and need operations more times than I can remember — and who has never once needed to pay a medical bill — I’m more grateful for socialised medicine than just about any other aspect of Canadian life. The care has always been timely, excellent, and free.

The system isn’t perfect, of course — perfect systems don’t exist — but the value of the peace of mind it offers is incalculable. Also, please remember that most horror stories Americans might hear are pretty much blatant propaganda from your politicians, corporate lobbyists, and the conservative media. It should be sufficient proof that the system works well that every Canadian I know would be aghast at the thought of trading our system for one like yours.

I really do hope, for the health-care future of America, that a President Obama starts things rolling in the direction the rest of the civilised world has realised is the correct one. You might just find your national life expectency starting to creep upward again.

i wonder what the implications are for intentionally/systematically pressuring a person to conduct business transactions when one knows or should know the person is not mentally competent because they’re wacked out on painkillers.

Sadly, this isn’t restricted to just for-profit hospitals. My wife had surgery at Inova Fairfax Hospital in Fairfax, VA in December. Inova is a not-for-profit hospital system in this area. During her recovery, she got up to use the facilities and by the time she got back, there was an invoice for her “estimated co-payment” (read: not yet submitted to insurance) with a note for her to call the billing department as soon as possible.

I recognize that they need to make ends meet… we all do. But she went through a registration process. They check ID and insurance before even admitting. They know how to get a hold of us. We sign paperwork that says we agree to pay our end of the bargain, by law. There’s no need to cause patients additional mental suffering during their recovery process.

Having once worked for a for-profit hospital company, I would never, never go to one. Beyond the usual billing scams like $15 per aspirin, diagnosis upcoding to maximize insurance payouts, overbilling uninsured patients, and so forth, these companies see absolutely no problem with violating federal health care guidelines (assuming any are left after the reign of George W) and putting patients at risk all to pad the bottom line. I’ve seen it.

By the way, while the approach from the billing agent was merely crass, the personnel who were visiting the drug resistant patient without protection were endagering the patient and violating all kinds of health care standards.

If he had been pre-registered two weeks prior, then why weren’t the payment arrangements made then? This makes no sense. Every time one of us has been admitted to the hospital for something planned, we’ve done the pre-registration and there are tons of documents to sign. Chief among them the one about “financial responsibility” and insurance coverage, out of pocket expenses, unforseen charges, etc…it’s ALWAYS abundantly discussed. The OP doesn’t say, but I imagine this was done with her father and they got a little over-zealous post surgery trying to collect.

@mycroft2000: The problem isn’t that people in the US don’t want free healthcare, it’s that they don’t want to pay for it. Canada and the UK have great healthcare systems…but you pay through the nose for it. Taxes in both of these countries are very high relative to what US citizens are accustomed paying. You can’t just jack up the tax rate to what would be necessary to pay for free healthcare and think that everything will just go over soooo well. People just don’t realize that healthcare costs money and it’s coming out of their pockets whether they want to pay through private insurance, increased taxes, or even more increased taxes when hospitals start going out of “business” left and right and the government decides to bail them out.

But our priorities aren’t on healthcare. Perhaps that’ll change with the next election.

I got to witness this at a not-for-profit hospital. I had a friend who had type 1 diabetes and she landed in the hospital a number of times. Of course she didn’t have insurance because she had a hard time keeping a steady job due to landing in the hospital from time to time or being sick.

One of the times I picked her up to go home someone from the billing department showed up before she had been discharged. This person demanded payment and when she refused because she had no money the billing person said they would not release her until a payment and arrangements on the bill were made. So they were basically holding her hostage for money she admitted she didn’t have. She finally told the billing person to stuff it, picked up her things and left without being offically discharged.

She said it happened every time she had ended up in the hospital. Before anyone starts blaming her, she was uncontious when dragged into said hospital so she had no say in racking up the bill.

Insurance only pays a presentage of the billed amount. I’ve seen bills for $300 which insurance only pays $30. The actual test probably costs less then that but if the hospital billed $30 they would only get a buck or two. That could be a reason uninsured costs are so high

@facted: Look at most people’s private health insurance, even through work as a tax. Were paying more in “taxes” than people in the UK and Canada if you lump insurance premiums here into a person’s tax debt. We pay more in insurance premiums through work in a month than we do for all other “tax” deductions combined.

I don’t socialized healthcare can work in america. Look at the crap returning vets are going through. Remember the scandal at walter read how patients were in the same room as vermin and other stuff. That place was supposed to be the poster child of government run healthcare. Then you will have all the fraud to deal with. It’ll get worse. Another possible problem is what about illegal emigrants? Costs will still stay high because they still need treatment. I BET with government healthcare we will be paying more for less service.

@facted: Canada is also a much smaller country than ours: 33mil to our 280mil. It would be _a lot_ harder to implement a fully socialized system in this country that’s anywhere near efficient. I think Obama pointed this out somewhere.

@facted: Actually, our tax burden isn’t all that much higher than Americans’. The main difference is that we have a huge chunk of our tax dollars going to health care, whereas the US has a comparable percentage going to its military. Before the Iraq disaster, the US could have easily (“easily” in the logistical sense, not the cultural one) cut military spending in half and put the savings toward health care, but, sadly, that’s impossible now.

It really boggles the mind (and is rather depressing) to think of all the good that the hundreds of billions wasted on Iraq could have done.

@Mr_Human: Each province actually runs its own healthcare system (Ontario has something like 12 million people), so if each US state were to do so, the implementation of a public system would be somewhat more manageable. Of course, then you’d run into the problem of a rich state like Washington having far better care than a poor one like Mississippi … You’re right, though, it does make a person’s head hurt to think about how difficult a change like this would be.

@hamsangwich: I technically get paid by the state of Massachusetts(personal care attendant paid by medicaid) the governer just denied us medical benefits, we are required to have insurance, I make “too much” for the assistance plans, I’ll have to give up my car to get this medical insurance, I need my car for work. It is SO not working in Massachusetts.

I do work with both groups. Its certainly disheartening as a medical student to see how crappy the system is, but its so broken at this point its really only a matter of time before change has to happen, simply because a complete collapse is inevitable.

Sadly, healthcare in America is about money first, the patient second–a distant second. How else to explain that we are number 1 in spending for health care and in the middle of the pack (among industrialized countries) in quality of care. Pathetic

When discussing national healthcare, if you can get beyond the knee-jerk reactions, think about the longer term savings. Sometimes it’s the poorest who need the most expensive treatments and are unable to pay. With a stable system, everyone will spend more time getting preventive checkups and early care and less time going in for expensive emergency treatments. Compare the cost of regular dental cleanings, checkups, and even braces to rescue plans involving fillings, root canals, crowns, veneers, etc. The savings are there.

@mycroft2000: One other thing – the provinces agree to honor each other’s residents and settle off regularly. So, if I’m in Vancouver and need my appendix removed, I still pay nothing and my province gets the bill (provided I’ve got my health card with me when I’m travelling.)

Yes, there are treatments and services the provinces don’t cover (vision, dental, outside-the-hospital-drugs, physio) but my employer supplies a plan for those that’s pretty generous. These plans very from company to company. For example, my plan covers 80% of doctor ordered physio claims to a yearly maximum.

My provincial health card and my employer paid benefit card, I never leave home without them.

Iam neither for or against national healthcare in America where I live. This is because of the outcome I see.
No matter what we go with it will basically not work. The reason for this is because of such corruption in the political and business enviroment in place in America. If we dont clean up the corruption in America we are going to suffer alot more in the future.

@hypochondriac: The billing system is really just a massive shell game. I think it is actually *illegal* for a care provider to charge less to a cash-paying (uninsured) patient than they would bill Medicaid…despite the fact they won’t have to pay office specialists to code everything and deal with reimbursement.

Funny how the health-care industry was going along just fine until the government decided to get involved…

Everytime I go the doctor, dentist, eye doctor, or any other health care professional I always get payment/cost arrangements ironed out BEFORE anything is done.

How can you not get that straight beforehand? How can you be upset when you didn’t take care of your business?

Somewhere in here I would have thought to myself, Man , I hope the insurance pays for all this.” Was that not a concern?

Then put it on the hospital employee who is just doing his/her job like it’s their fault that you didn’t do you due diligence. It’s like the speeder who gets mad at the cop for writing him/her a ticket.

When you go to get your car repaired do you not make sure the costs/expenses are known and taken care of before any work is done?

When you get some work done on your house do you make sure you know how much it is going to cost before the work is done?

Sick people and their family expect special treatment because they don’t feel well. Just because your sick doesn’t make you special or immune to the rules.

@mycroft2000: That is quite possibly the most succinct, calm explanation of my feelings I have ever seen. Bravo. (Brava?)

While travelling in the states the last two weeks, the thing that was perhaps most shocking to me were the advertisements for hospitals on the radio, the way one might advertise hamburgers, though instead of proclaiming best fries, a given facility advertised best cardiology departments.

My mother has dual citizenship, and is flat refusing to move back to the US after her divorce, as the health care alone would kill her. Another friend of the family, over 90 years old, was billed $40,000 for a hip replacement when he fell at US customs and they took him to Buffalo instead of St. Catharines. The US system is fantastically broken, and it seriously makes me question where I’ll attend graduate school – This is one thing I really do not want to have to worry about.

Every hospital has a patient/nursing ombudsman. Usually a senior nursing supervisor that is dedicated to handling difficult patient complaints…. and I don’t mean complaints from “difficult patients”.

The patient/nursing ombudsman may even has the power to fire. Regardless of his/her power, he/she always has the ear of the hospital administrator, the director of nursing services and the chief medical officier.

In situations such as this one, he/she is GOD.

There would be no “courtesy” call, as the patient/nursing ombudsman would understand the effects of the drugs and the liability to the hospital.

The first thing I do when a family member is in the hospital is find the patient/nursing ombudsman’s office and telephone extension. It does wonder’s just saying “wait, let me call Nurse Smith’s office and discuss the treatment program with her”.

Some of you guys confuse the crap out of me. In one post you state how screwed up the US Gov. is and how incompitently it runs things. Then in the next you say “Universal Healthcare” is a good thing. So in Bizarro world its a good thing for incompitent organizations to run something?

@Elviswasntmyhero: Dick Cheney wasn’t lying. He is receiving the best health care in the world. Socialized health care. He (and his Republican ilk) just want to keep their free, socialized, lifetime health care for themselves, while private sector people tough it out on their own.
Rational for them, although it makes me wonder about the suckers they con into thinking it’s some horrible, Communist plot. One that the entire industrialized world except us “suffers” from.

@trk182: Try this on for size: it may make everything else clearer. Yes, the government is often fucked up. The for-profit health care industry is even more fucked up. Clear now?

As an example, I once did ancillary PR work (on another product, thank God), for a company who in 1985, found out that most of the stockpiled clotting factor that they made for hemophiliacs was infected with HIV. So what did they do? Why, they sold it in unregulated Asian and Latin American markets, of course. As did their competitors.

I’ll take my chances with the US government. For-profit health care is just pure evil.

@planetdaddy, did you not read the OP? If there’s anyone not “doing due diligence”, it’s the hospital. Her dad pre-registered TWO WEEKS BEFORE THE SURGERY. If the hospital had issues with his billing or ability to pay, they could have contacted him then–and told him if he didn’t do X, Y and Z, the surgery would not go forward.

The visiting his room without protection thing is typical. I’ve never been in a hospital where half of the medical personnel bothered to wash their hands or act like they gave two craps about transmitting germs to the patients.

What do you expect when having insurance doesn’t mean the insurance company will pay up? Our government needs to get off their buts and legislate some laws that ensure insurance companies have to pay out claims.

This is not a matter of any “screw up”. This is the hospital making a deliberate choice to try and get cash out of the patient immediately, regardless of payment arrangements or insurance forms prepared ahead of time. It’s not the consumer’s job to think about, and close off, every single avenue possible by which the hospital can try and screw you.

Speaking of hospitals reminds me a little of an anecdote, from an acquaintance who is a medical malpractice lawyer, about just how desperate some people are to blame the victim. Acquaintance was picking a jury in a case where the entire alleged malpractice and resulting injury occurred during surgery, while his client was under general anesthesia. He was sure there was NO WAY that any juror could come to the conclusion that the patient–who was unconscious and immobile–could be blamed for it.

Ha. You knew better. “Well, it’s HER fault for picking that doctor!” And no, this was not one lone wacko. Several other potential jurors nodded.

I’ll take this story one step further. My brother’s in-law’s daughter had leukemia, and had an unsuccessful bone marrow transplant. Yes, unsuccessful, as in she passed away. Before her parents left the hospital, one of the onc. labs had already started trying to shake them down for money (even though they had full insurance).

Eventually the insurance paid everyone except (ironically) the lab for a couple hundred dollars worth of lab work. The lab started harassing the parents at home, while they were still grieving their loss. I was in the living room overhearing one of the conversations they had, and their (the parents) end went something like this: “No, we’re not going to pay you for this, now or ever. If you want the money, you can go chase down the insurance company, or sue us. And I hope you chose the latter because I’d love to tell a judge how you shake down parents who just lost their child to leukemia.” and hung up. Never heard from them again.

I was in the hospital for 13 days after being hit by a car, in a parking lot, by an old (not quite all together senior). Anyway, I am on Federal Insurance, and the insurance company was sending me the checks from all these docs and services i really had no idea about. But 18 months later, i get a med billing service calling me giving me the demand for a big total. I called the insurance company and asked why they took so long, and this is what i was told OFF THE RECORD. The billing group has 2 years to bill, and they know you got the checks, (well what about the Time Value of Money?) so what was the hold up…. still OFF THE RECORD now, the billing company knows it is a Federal insurance company, actually BCBS, and they try pushing the insurance company into accidently, mindlessly, stupidly into paying. Then once they got that payment, they come to me. There is more here that smokes up the situation, like Third Party Options, and Trauma Care, and big settlements. But I wonder if this situation is the same scam but in reverse. How many people actually check to see what their insurance company was billed and what they actually paid. And how familiar are most people to what their actual out-of-pocket charges are going to be? I usually let the insurance company inform me what my share of the bill i need to pay. But if you are drugged up, hurt’in, and can think of nothing but gett’in hell out of there, i can see how easy it could be to be taken advantage of, not a cool thought. And who tells your insurance company what you paid. There are services available that will review your bill from the hospital and negotiate for a percentage, the reductions they come up with from overcharges. These people are usually ex-billing people.Ever tried to analize a medical bill? all those secret codes……

@scoobydoo: I agree that things suck today, but disagree that nurses will be involved in the further degradation of services. To whit:

1. Nurses generally care about the patient, not the payment.

2. Nurses are generally the most powerful. They may say “Gosh, I can’t stop billing from talking to you”, but they can say “I won’t talk to the patient about billing, that’s your job.” And they have the power to refuse to get involved in that BS – because of the general shortage of nurses in America.

Like I said, services will continue to degrade, but I won’t agree that nurses will be the driving force behind that degradation. They have too much autonomy.

@Vulcaex: Please don’t be sardonic on topics you don’t seem to know much about. The “long lines” canard is well-worn, and mostly untrue. Yes, there are longer waits for SOME elective procedures, but no Canadian ever has to cross the border on his own dime to get his life saved. Sometimes, when hospitals are full (which only happens in relatively remote areas), the government will fly seriously ill patients for treatment in the States, but … and this is very important, so please remember it … the government still pays all costs for these patients.

You may well be able to dig up a story or two about the system somehow screwing up, but for each one of those, there are a hundred thousand successes that don’t make the papers.

@WEGGLES90: Sure, just report in to a care provider and… wait. Wait more. Wait longer. Need a specialist? Wait even longer. 4 week wait for a specialist and 4 hour wait for care in an ER. Need an MRI? You’re in Saskatchewan? Better have requested that MRI 22 months ago, cause that’s how long you’ll wait.

That’s some mo better medical care. I’d rather pay out of pocket than wait ’till I die to get care.

Based on my experience, the hospitals and such plain don’t want to be paid, except by insurance. I just paid debt collectors. I told them that if they would just hold on a bit, I’d get to where I could pay them. If you’re turning someone who is willing, but unable to pay (nothing saved, needed ‘new’ car, needed to fix up ‘new’ car)…I’m not offering sympathy. Once I had myself squared away, it only took one month’s pay to take care of it; but, I needed almost all of those previous months’ pay to handle non-medical recovery.

How much of that ~$1600 went to the people that actually did work? Though, even that is optimistic on the hospital’s side, since I spent the majority of my time sitting around waiting, and got charged about $600 for sitting in a room waiting. FYI, insurance covered $33, and this was under 2 months from the deductible resetting. Of course nobody was in-network, I had no way to check, and I know that it’s by design, to make the plan look better.

@trk182: it’s like voting for a party candidate. The private/public system we have (make no mistake, the government is highly complicit) is working like crap. Universal health care is not going to make it work perfectly. But, our current system cannot go up from where it is, only down. What incentives are there not to try for universal care, or socialized health care, with a separate private sector of health care?

I would like free health care. Yeah, it cost more, but imagine having most everyone working to help you, without so much worry about where the check is coming from?

Could be worse. I read that when you visit the hospital in Vietnam to have a baby, and you can’t pay your bill, they sell the baby. In China, they can and will refuse life-saving care if you can’t pay up-front.

@facted: And the American people WANT to pay for the war in Iraq and Afghanistan?? The $295 BILLION spent in the last fiscal year to fund those wars is WAY more than a national health care initiative would cost to cover each and every American!!!

@hypochondriac: I am a health care professional … and even 20 years ago, I was working in a community that was served by two community hospitals and a VA Medical Center. Even back then, the common saying was “there’s the right way, the wrong way, and the VA way … and the VA way is neither of the other ways.” So comparing “socialized medicine” in America to the VA Medical System isn’t a good or accurate yard stick to measure against. Even today, the local VA Medical Center is no different than the one that was across town from where I worked 20 years ago!

I had an infected kidney that nearly killed me and that they had to take out. The hospital discharged me barely able to walk, and on narcotics for the pain, but that goddamn financial bitch was there, asking me how I was going to pay for it. I had just enough presence of mind to refuse to sign any forms, to ask where the itemized bill was, and to say that I was not paying them one thin dime without going over said bill with my insurance company. After I got home, they called me repeatedly asking when I was going to pay. I just kept asking them when they were going to cough up the itemized bill for me to go over with my insurance company. Finally they stopped calling.

“Before the Iraq disaster, the US could have easily (“easily” in the logistical sense, not the cultural one) cut military spending in half and put the savings toward health care, but, sadly, that’s impossible now.”

Except that before the Iraq disaster (and still to some extent), US military power lets the rest of the Western world skimp on their military. If the US didn’t spend as much, the rest of the world would have to.

I’m not super-gung-ho about the US military, but it does (or did) provide the world a decent safety net. Plus, the US Navy used to spend a good amount of time keeping int’l waters clear of pirates, which is good for everyone.

I am a student nurse in clinical rotation at a HCA hospital in Brandon, FL, and surprised at the many charity cases that are admitted as such, treated, given vouchers for medications and even a voucher for the taxi home. As a tree hugging liberal and ardent leftist, it also surprises me to see “insurance” rates for the unisured.

@hamsangwich:
Like the original poster said — they could have gone over financial issues with the patient prior to admission. Of course the hospital has a right to take steps to make sure they get paid, but this must be done in an ethical fashion. Hassling someone post-op is not ethical. There is no excuse for this type of behavior.

padding the medical bills….my bride was in the hospital…i was visiting at the time a guy? stuck his head in the room door, and asked my bride how she was doing…..after her release we looked over the statement and found a consultation fee to a doctor my wife didn’t know….the only thing we could come up with ,it was the guy that asked her how she was doing….

@richcreamerybutter: You’re right. That Armey guy is just ridiculous according to a transcript of the debate. Liberty this, liberty that. And if we have the so-called “best healthcare system” in the world, why must we jump through so many hoops? Is it our American Liberty to be nothing but circus animals in the show called Capitalized Healthcare?
Health clubs, Netflix, regular insurance has the right idea, everyone pays the same amount (either a percentage of taxes or a fee) no matter how much is used. Why can’t we seem to do that for friggin’ healthcare? Because everybody wants to be insured, and everybody= lots of customers for profit.

Here is the core flaw of US private health insurance. The companies select only the healthiest people and reject those who really need insurance. Those with chronic conditions, past history of something like cancer or those who are old are rejected or priced out of a policy. Even group policies are prone to this through claim denial, removing people from group coverage (some can do this) and structuring benefits to work against someone needing to use larger amounts of care.

This is why we have so many people filing for bankruptcy due to medical bills and most of them even had insurance. A Harvard study showed over half of the bankruptcies were due to medical bills.

There is a reason that hospitals used to be run by religious groups, it was because health care wasn’t seen as a profit making business but a humane care for other people.

This is nothing new. Back in 1995 I went to a public hospital emergency room. The billing department insisted that I pay before receiving treatment (against the law). I told them that I didn’t have any money until payday. The woman insisted that I pay before I saw a doctor. So I wrote her a bad check, and told her, this is a bad check. A week later the check was returned due to insufficient funds funds. I took the returned check to the billing department with cash to pay the bill. I walked up to the same woman explained to her that I was there to pay the returned check. She insisted that she never would have told me that I had to pay before I received treatment. This was all before the hospital was privatized, I’m sure its so much better now. Maybe the tornado that hit the hospital last year was Carma.

I’ll chime in and add my disappointment with the health care system also.

I was injured at work and see a doctor every three months to get a prescription. The company I work for has denied every office visit bill sent to them out of hand and I get calls from the billing department on a regular basis. It’s not like this was under dispute or anything. The insurance company accepted the claim two years ago and I never had a problem until they started denying the office visit claims. Seriously considering seeking the advice of an attorney now, as it has gotten to be a bigger hassle than I can deal with at this time.

I had a friend that was involved in an accident once. He was riding his bike (on the sidewalk) and a driver hit him, causing some minor injuries. The police were called (along with an ambulance) and even though my friend didn’t want any medical help, the police officer FORCED him to get into the ambulance and go to the hospital. I met him at the ER and luckily he didn’t have his ID and wallet with him (I had taken his backpack home and stored it for him) because they were refusing to treat him without any insurance card/payment. My friend told them that he was there against his will and was fine with not getting any treatment and just wanted to leave. Finally the billing person left to answer a call and both me and my buddy slipped out the side entrance and went home. I had no idea that people involved in an accident could not refuse to be transported to the hospital.

I’m seriously considering not carrying my ID with me when biking anymore for this reason. I can’t afford to pay a doctor bill either and don’t want to be charged some huge bill for treatment I don’t want and didn’t ask for.

@nonzenze: I have an idea, albeit not original … let’s stop being the world’s “safety net” or “policeman” … and start taking care of our OWN people! Once we can better care for our own people, then we can help the others. And if we can take better care of OUR citizens, perhaps the child that receives the education he/she wouldn’t have otherwise received, or received the health care he/she wouldn’t have otherwise received and would have died without … will go on to find cures to our medical problems and create new things that will forever change our lives. THAT is how we can best help the rest of the world, IMVHO!

The problem isn’t that people in the US don’t want free healthcare, it’s that they don’t want to pay for it. Canada and the UK have great healthcare systems…but you pay through the nose for it. Taxes in both of these countries are very high relative to what US citizens are accustomed paying.

These people who have these heath care policies where they have to pay large amounts at the hospital…are they reading their contracts/paperwork? I have an HMO with the highest coverage level so I won’t be put in this position (owing thousands of dollars) if I need “catastrophic care” or just plain old hospitalization. It’s not Cadillac healthcare like Blue Cross, but then, I don’t pay Blue Cross prices. Something has to give.

There’s another piece of this puzzle, which Michael Moore (unusually) got right. Most people blame the pharmaceutical industry’s outrageous pricing, and don’t get me wrong. The pharmaceutical industry can be evil at its most evil. HOWEVER. That industry adds something useful to the system. They may gouge us for every cent they can get, but they do, in fact, provide value.

The insurance industry, by sharp contrast, was set up to collect money from the broadest possible pool of patients, and to use the money from healthy patients to subsidize care for the sicker ones, thereby spreading the risks. The trade-off for healthier patients was the guarantee that, should something happen, or as they age, they too would have coverage. However, the industry now tries to do the exact opposite of this: eliminate sick patients, collect from healthy patients, and turn the cash overflow into shareholder profits. In otherwords, the industry is getting massive profits out of the system in the form of premiums that would otherwise have provided care for sicker people, and turned it into cash in the wallets of investors. They do absolutely zero for the healthcare system. They are parasites, weakening the system. And it’s time we got them removed.

Having worked for a for-profit hospital (recently shut down due to chapter 7 bankruptcy), this sort of story is not at all unfamiliar. The “financial counselor” (we called them “case managers”) only has one reason for existence, and that’s to save/make the hospital money.
As for the patient that was not being properly handled, that’s a huge JCAHO (Joint Commission) violation and the sort of thing that can shut a place down. JCAHO membership is voluntary for hospitals, but once you’re a member, you better adhere to the rules. I’d report it.

Ah, yes, Bizarro Imaginary Canada, where residents stare longingly at the border and wish they could come to the US instead of waiting three years to get their appendixes out. Poor Bizarro Imaginary Canadians! If only they lived in real-world Canada, where those long lines of people waiting for US healthcare don’t exist.

Insurance companies used to be in the business of selling policies and paying claims, making their money by accurately judging the odds. Now they’re in the business of taking premiums, investing them, and paying as few claims as they possibly can….even if it means denying or stalling perfectly valid claims.

@Here_we_go: I’m in Health Administration and I was a nurse before, granted for a short time. I agree that the hospital needs money, but I do not condone chatting with elderly, incoherent patients. They’ll agree to anything to feel better. Such a huge portion of the staff that wander in and out of patients rooms are uninformed tech-like people, or nursing staff that have no idea what it takes to get a medical claim to clear and subsequently be paid.

Hospitals are a business anyone who tells you different is delusional. They need to make money just as desperately as Wal-Mart. But people get lost in thinking that they exist for the good of man. Sadly, they exist for both the good of man and to generate revenue.

Also? I’ve recently run into a number of people that think that not-for-profit companies (and hospitals) do not need to make money. I’ve tried to educate them, but I’m wondering how many people think this.

@bohemian: In case you didn’t know, and for the benefit of everyone, it’s called Adverse Selection. It’s the best way to make money.

When I was in college (I’m still finishing, but have insurance now) I had a plan that cost $60 a month and had a $5000 deductible for everything. I wouldn’t go to the doctor unless I was dying or coughing up blood.

It is exactly the way they make money. This degree is Health Administration has only made me want to be a rabid lobbyist for human rights.

@hypochondriac:”I don’t socialized healthcare can work in america… Another possible problem is what about illegal emigrants? Costs will still stay high because they still need treatment.”

I disagree with that: with a public health system, comes the need for a justifiable identity card system. Every single one of those illegal immigrants would have to prove they are American citizens in order to geth their health card (you didn’t think people just walked in and got served, did you?). Imagine socialized healthcare as merely insured health coverage with $0 deductible.

@cosby: @Here_we_go: I agree with both of you. And to think that Republicans want ALL hospitals and insurance to be privately owned (and therefore, for-profit mostly), I can’t think of how much worse it’s going to get *shudder* And that’s why, despite being a strong conservative, I am a proud Democrat

@hamsangwich: I totally agree with you on that one, but I wish it was possible… stupid politicians…

@mariospants: Something like that would be great… if they weren’t so easy to forge xD
On a serious note, it’s a great idea in practice, but two big problems exist:
1) ID theft – but preventative measures can be taken
2) forgery – the government would never work hard enough to prevent it, thereby rendering the cards useless

@planetdaddy: It isn’t always possible to pre-arrange the financials. Last month, on a Sunday, I had to take my wife to the acute care center owned by a local hospital. I tried to find out how much it would cost while we were there, but no one on the staff there even knew how much any service, procedure, or medication cost. They said that everything was billed later by a separate department and to wait for the bill in the mail.

No wonder medical costs are sky-high and climbing steeply. When people don’t even know what things actually cost, there’s no incentive to “shop-around” (if possible) and no incentive to charge what the market will bare.

@jennieblue22: And somehow, healthcare in Canada still manages despite these issues. Not saying that they don’t exist, but they’re an acceptable loss when compared to the huge benefits. Like having doctors actually work on patients rather than chase after insurance companies.

@LogicalOne: This is essentially the critical failure of trying to apply free-market mechanics to healthcare (on top of the critical failures applying free-market mechanics to everything else, but that is a discussion for another time): the customer is rarely in a position to (realistically) bring their business elsewhere. There is no pressure to perform, as they know that their customer base is pretty much guaranteed.

The U.S. spends up to twice as much per-capita on health care as other industrialized countries with socialized health care, yet gets worse outcomes as reflected in health statistics. I know I pay far more for insurance (I’m self-employed) than I’d pay in taxes for a government plan.

About 20% of US health care dollars go to insurance administration and profit. Medicare, run by the inefficient, incompetent, government, eats up only 5% in administrative costs.

Under Clinton, the VA health system was cleaned up. It became recognized as one of the best, most efficient systems in the country. Walter Reed et al. are not VA hospitals – they are run by the military. The mold, poor care and other problems can be laid at the foot of GW Bush. Thanks tooutsourcing and cost cutting we’re getting what we pay for. Support the troops my a**! Now he wants to outsource the VA.

@Guizzy: I don’t disagree with you but what is wrong with upfront disclosure of prices? Certainly price should not be the first consideration for selecting or providing treatment, but shouldn’t it be a somewhere on the list of considerations?

Secondly, third-party payer systems aren’t just part of the solution, they’re also part of the problem:1. When people depend on insurance to pay, they no longer care what it costs; as long as the policy covers it, then let that big, rich insurance company pay the bill. This holds true for both patients and doctors alike. When doctors know that there’s insurance, they charge more and feel less constrained about ordering or reccommending more tests or procedures than absolutely necessary. As a corollary, hospitals have spent the last fifty years spreading actual costs from one line item to several others, in the hopes that by doing so, they could subsidize the costs of the one. (Your $10 asprin helps pay for the indigent patient in the next bed.) By now, I doubt that hospital accountants even know how much anything really costs anymore.2. Insurance adds another layer of costs onto the system. Not only do you have to pay for the actual service, but now you also have to pay for the paperwork, both the providers and the payers, and the insurance company’s costs and profit.

I don’t doubt that there needs to be some mechanism for paying for the truly expensive care. Fifty years ago, it used to be that insurance only covered major medical: those services and costs that no one would expect an ordinary person (i.e., not rich) to be able to pay. Over the years, the coverage has expanded to cover a whole lot more and the expenses have risen exponentially. (Imagine what your car insurance would cost if it now covered things like oil changes, tuneups, and mechanical failures.)I think we need to retreat from this level of coverage. I don’t think it would be too out of line to expect most folks could afford the first 3-4 thousand dollars of their family’s medical bills per year, especially if their insurance premiums would fall to take into account their lowered coverage. That, coupled with more open price disclosure could help rein in costs.

Most people confuse socialized medicine with what is being proposed by the democratic candidates. They are proposing access to the federal employee medical insurance for everyone at a significantly reduced rate. Whether or not insurance would be mandatory is their only quibble. While this would have some effect on the ever rising cost of medical care, it would not have the same cost containment as the single payer system.

Single payer will require hospitals and medical professionals to live under a centralized billing structure which would cause an immediate cost containment for services. Physicians will tell us this would not work and would lobby hard against this, but the main effect would be their inability to charge two or three times the gong rate.

Neither of these systems solve the primary problem in regards the medical system, that it is a business which is under continuous pressure for financial gain where, regardless of individual caretakers desire to care for their patients, they are constantly over-ruled by the health services administrator or health-care patient representative.

Having gone through terminal treatment with my father this year, I feel that their are two major problems with any system which uses financial costs as a measurement of service

First, the necessity to move the patient back and forth between different levels of care to contain cost. When an acute situation exists, the patient is treated with the highest level of care. Once the patient is no longer acute, they are moved to a long term nursing facility, where the level of care is minimal. Most patients whose illness will take more than 10 days will go into this system if they must stay under nursing care. The problem is that patients are constantly infected at the nursing facility, and are then moved back to the hospital for a day or two and then returned to the facility. It’s like spending one day in first class and then 29 days in a over-crowded subway car.

Secondly, regardless of what is seen of the various tv shows, risky surgeries are rarely attempted without the financial aspect being resolved.

The social systems of Scandinavia and GB rarely (if at all) have issues arise that have to do with cost, only with need and demand.

I was diagnosed with cancer at age 34, now at 37 I am unable to get “any” insurance, nada. They don’t want to know me from Adam. My extreme contingency plan if I need treatment again or need to go to the hospital is to go without any ID and try to get away with being a Jane Doe and not getting billed. What else can I do? It is wrong I know. I have to make a choice, get treatment, live and try to avoid the extreme stress of having mountains of med bills or having to file bankruptcy. My previous plan was to just get treatment and then file for a BK. I have very few options in my situation. I am self employed so an employer plan is not an option. I earn just enough money to pay my rent and survive. Any one here from Canada want to get married? I’ll hop in my car and be up there before you know it. In my own pitiful way I am just trying to show that universal healthcare and high taxes that would go with it seem like a small price to pay so I can make it to 40.

@Here_we_go:
This is not only true of the Health Care Industry but basically just about any industry that uses a Capitalist Operating Model. No need for comments of “thanks captain obvious” butt-holes and personal opinions aside, this tragedy happens everyday here. What gets me is even this site has Ads on it. Funny yes, sickening definitely. I am not saying stop reading this site, it’s great, the point is that Capitalism destroys people, humanity. “Yay for for Socialist Commie!” right? No, here’s a suggestion…Ever punched a US Senator in the face, or in talking to the CEO of a multi-billion dollar corporation asked him, why he jacks off to seeing people rott in a heap of financial mess and tyranny? WE’ve heard it time and time again, people like Clinton, Obama, you know who im speaking of. “it’s time for Change” blah, blah, w/e. The fact is unless you act it will not happen. Am i telling you to punch a US Senator of CEO in the face?….absolutely!

@facted: We just got back from a trip to England to visit my DH’s family. While the NHS is, IMHO, overall a good thing, I would not say it’s “great.” One of my DH’s uncles may have to come to the U.S. and pay for his own cataract surgery, because it was denied by the NHS. (Another family member said she’s mystified as to why it’s not covered, because her own father’s cataract surgery was, and his weren’t nearly so bad.)

Another uncle had to purchase private insurance to get a health issue treated that the NHS doctors had completely ignored.

And I have a friend in Ireland who told me that the government there is actually sending people who need major surgery to France, because the Irish hospitals are simply too backed up to get to them in time.

I think the reluctance among most Americans to implement some sort of national health care scheme stems from two things:

* The inherent ability of the government to screw up EVERYTHING.

* The fact that those of us with good private insurance would probably receive lesser care under an NHS-type system than we currently do. And, let’s face it, the folks who make the laws already have great insurance, so they don’t want to end up with something they’re going to see as subpar.

I don’t know what the solution is. Clearly, the current system isn’t working. Maybe some sort of government-subsidized health insurance that’s available to everyone? You’d have to force all doctors and hospitals to accept it, though, to make sure that they were treating the people who needed treatment … I don’t know. This sort of thing makes my brain hurt.

@hamsangwich: That’s great except the state of MA is a total mess right now and losing millions of dollars as a result of this program. As an employed resident of the state, I have NO options now for health insurance, whereas before I could sign up for any plan I could afford. I have to accept what my work offers me, which is awful insurance. I can’t get anything else because I make less than 30k a year and make too much to qualify for Medicaid. If you lose your job, you’re screwed, it takes over 6 months to sign up for the state insurance and then you don’t get your state tax returns for 2009. So yeah, things are better off as they are… the state should have NEVER made insurance mandatory.

@Sanveann: When I was in Hong Kong recently, I had a somewhat urgent medical issue come up. I called the hotel front desk, and a doctor came to my room, asked a few questions, and then advised me to visit a clinic first thing the next day. I went to the clinic, they ran some blood tests and x-rays and another doctor talked to me about what was likely going on and cleared me to finish my travels.

Since my health insurance policy didn’t cover issues that occurred outside the US, I had to pay out of pocket. So, to review, I had a “house call” at 10PM from a doctor, then an in-clinic visit that included blood draw & same-day lab work, X-rays, and another doctor consultation.

Total cost: US$150.

I don’t know how they do it, but this was not subsidized care I received. In fact, they made a point that they “upcharged” me because I wasn’t a Hong Kong resident. This was the full-charge, no insurance cost. In any US hospital, it would have easily been $500 or even $1000.

We need to figure out what Hong Kong is doing. It’s definately not all about nationalized care. Their full-priced care is just less expensive. *shrug* FWIW

@jennieblue22: If you’re a proud republican you’re an idiot. If you’re a proud democrat… you’re still an idiot. A republican wants to take what you have and give it to his boys in Industry. A democrat wants to take what you have and give it to some undeserving slob. At the end of the day what difference does it make to you?

@mycroft2000: Not to mention, Canada’s system costs its government less than our system costs ours.

There is just no upside to our health care system as it exists, that I can see. It’s morally irresponsible, fiscally fscked, and it’s destroying our position as a world leader in medical sciences. They can’t change things too MUCH for my taste!

I still haven’t paid my last hospital bill and we’re still going over it:

they billed me *** 45 *** times the real cost of medication but are very good a dodging questions.

they also billed me for an alchool / drug test although I told them I don’t drink / take drugs, and I refuse to pay for it. they also billed me for services they did not perform.

And the funny thing: I asked if I could get saline solution for my nose (very cold / dry due to the AC and I had a nose bleed), they brought me the stuff you buy for $2-3 off the shelf at CVS, billed me $15 for it + $140 for a doctor’s prescription. I am NOT going to pay this.

If the costs were realistic, I’m sure more people would pay.

We need a reform, and not one that changes and improves things and will eventually suck, but one that resets things from scratch, even if half of the insurance companies get out of business in the process.